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Ultrasound-guided preoperative localization of breast lesions: a good choice

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Abstract

Purpose

The aim of the study was to verify whether ultrasound (US)-guided preoperative localization of breast lesions is an adequate technique for correct and safe surgical resection and to contribute positively and effectively to this topic in the literature with our results.

Methods

From June 2016 to November 2016, 155 patients with both benign and malignant breast lesions were selected from our institute to undergo US localization before surgery. The lesions included were:

  • sonographically visible and nonpalpable lesions;

  • palpable lesions for which a surgeon had requested US localization to better evaluate the site and extension;

  • sonographically visible, multifocal breast lesions, both palpable and nonpalpable.

US localization was performed using standard linear transducers (Siemens 18 L6, 5.5–8 MHz, 5.6 cm, ACUSON S2000 System, Siemens Medical Solutions). The radiologist used a skin pen to mark the site of the lesion, and the reported lesion’s depth and distance from the nipple and pectoral muscle were recorded. The lesions were completely excised by a team of breast surgeons, and the surgical specimens were sent to the Radiology Department for radiological evaluation and to the Pathology Department for histological assessment.

Results

In 155 patients who underwent to preoperative US localization, 188 lesions were found, and the location of each lesion was marked with a skin pen. A total of 181 lesions were confirmed by the final histopathologic exam (96.28%); 132 of them (72.92%) were malignant, and 124 of these (93.93%) showed free margins.

Conclusions

US-guided preoperative localization of sonographically visible breast lesions is a simple and nontraumatic procedure with high specificity and is a useful tool for obtaining accurate surgical margins.

Sommario

Obiettivo

Lo scopo dello studio è di verificare se la localizzazione preoperatoria eco-guidata delle lesioni mammarie sia una tecnica adeguata per una corretta e sicura resezione chirurgica ed è altresì quello di contribuire positivamente ed efficacemente, con i risultati ottenuti dal nostro istituto, all’approfondimento di questo argomento nella letteratura scientifica.

Metodi

Dal giugno 2016 al novembre 2016, 155 pazienti con lesioni mammarie benigne e maligne sono state selezionate dal nostro istituto per sostenere una localizzazione ecografica prima della seduta chirurgica.

Le lesioni considerate sono state:

  • lesioni ecograficamente visibili e non palpabili;

  • lesioni palpabili per le quali il chirurgo avesse richiesto una localizzazione ecografica per meglio valutarne sito ed estensione;

  • lesioni mammarie multifocali, ecograficamente visibili, sia palpabili che non palpabili.

La localizzazione ecografica è stata eseguita utilizzando trasduttori lineari standard (Siemens 18 L 6, 5.5–8 MHz, 5.6 cm, ACUSON S2000 System, Siemens Medical Solution).

Il radiologo ha utilizzato una penna per uso cutaneo per marcare il sito della lesione ed ha, dunque, calcolato e registrato profondità e distanza dal capezzolo e dal muscolo pettorale.

Le lesioni sono state completamente escisse dal team dei chirurghi mammari e i campioni chirurgici sono stati inviati al Dipartimento di Radiologia per una valutazione radiologica ed al Dipartimento di Anatomia patologica per una valutazione istologica.

Risultati

Nelle 155 pazienti, che sono state sottoposte a localizzazione ecografica pre-operatoria, sono state riscontrate 188 lesioni e il sito di ognuna di esse è stato marcato con una penna ad uso cutaneo.

Un totale di 181 lesioni è stato confermato dall’esame isto-patologico finale (96.28%); 132 di queste (72.92%) sono risultate maligne e 124 di queste ultime (93.93%) mostravano margini liberi da malattia.

Conclusioni

La localizzazione preoperatoria eco-guidata di lesioni mammarie ecograficamente visibili è una procedura semplice e non traumatica con un’elevata specificità ed è una metodica ideale per l’ottenimento di margini chirurgici indenni.

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Authors and Affiliations

  1. Department of Radiology, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Giorgio Carlino, Pierluigi Rinaldi, Michela Giuliani, Rossella Rella, Enida Bufi, Federico Padovano, Chiara Ciardi, Maurizio Romani, Paolo Belli & Riccardo Manfredi

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  1. Giorgio Carlino
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  2. Pierluigi Rinaldi
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  3. Michela Giuliani
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  4. Rossella Rella
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  5. Enida Bufi
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  6. Federico Padovano
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  7. Chiara Ciardi
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I confirm that all the authors have made a significant contribution to this manuscript, have seen and approved the final manuscript, and have agreed to its submission to “Journal of Ultrasound”.

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Correspondence to Giorgio Carlino.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Carlino, G., Rinaldi, P., Giuliani, M. et al. Ultrasound-guided preoperative localization of breast lesions: a good choice. J Ultrasound 22, 85–94 (2019). https://doi.org/10.1007/s40477-018-0335-0

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  • DOI: https://doi.org/10.1007/s40477-018-0335-0

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